Sporcu Kalbinde Benign Elektrokardiyografi Bulguları
Özet
12 kanallı EKG sporcuların spora katılım öncesi değerlendirilmesinde ve periyodik değerlendirilmelerinde birçok uluslararası kardiyoloji otoritesi tarafından önerilmekte ve ülkemizde de çok sıklıkla kullanılmaktadır. 12 kanallı EKG, kullanımı sık olmakla beraber doğru yorumlanması tecrübe gerektiren ve sporcu sağlığını değerlendirmede hayati öneme sahip bir tetkiktir. Düzenli ve sürekli yoğun fiziksel aktivite yapan sporcuların kalplerinde elektrofizyolojik, yapısal ve fonksiyonel adaptasyonlar sebebiyle sinüs bradikardisi, ektopik atrial ritim, akselere junctional ritim, birinci derece atrioventriküler (AV) blok PR> 200 ms ve ikinci derece tip-1 AV blok (Wenkebach) sık görülmektedir. Sporcu kalbi ile ilgilenen hekimlerin bu fizyolojik değişiklikler hakkında bilgi sahibi olmaları ve özellikle 12 kanallı EKG’de normal ve patolojik bulguları iyi bilmeleri gerekmektedir. Benign EKG bulguları olan sporcularda ileri incelemeye gerek duyulmamaktadır. Fakat benign olmayan EKG bulgusu olan sporcular ileri incelemeye tabi tutulmalıdır.
Referanslar
Sharma, Sanjay, et al. "International recommendations for electrocardiographic interpretation in athletes." European heart journal 39.16 (2018): 1466-1480.
Fritsch, Peter, et al. "Cardiovascular pre-participation screening in young athletes: recommendations of the Association of European Paediatric Cardiology." Cardiology in the Young 27.9 (2017): 1655-1660.
Prutkin, Jordan M., and Mathew G. Wilson. "Electrocardiography in athletes: normal and abnormal findings." Heart 104.23 (2018): 1902-1909.
McClean, Gavin, et al. "Electrical and structural adaptations of the paediatric athlete’s heart: a systematic review with meta-analysis." British journal of sports medicine 52.4 (2018): 230-230.
Stein, Ricardo, et al. "Intrinsic sinus and atrioventricular node electrophysiologic adaptations in endurance athletes." Journal of the American College of Cardiology 39.6 (2002): 1033-1038.
Meytes, Ilan, et al. "Wenckebach AV block: a frequent feature following heavy physical training." American heart journal 90.4 (1975): 426-430.
D’Souza, Alicia, et al. "Exercise training reduces resting heart rate via downregulation of the funny channel HCN4." Nature communications 5.1 (2014): 3775.
Calore, Chiara, et al. "Prevalence and clinical meaning of isolated increase of QRS voltages in hypertrophic cardiomyopathy versus athlete's heart: relevance to athletic screening." International journal of cardiology 168.4 (2013): 4494-4497.
Sathanandam, Shyam, et al. "ECG screening criteria for LVH does not correlate with diagnosis of hypertrophic cardiomyopathy." (2009): S647-S647.
Zaidi, Abbas, et al. "Clinical significance of electrocardiographic right ventricular hypertrophy in athletes: comparison with arrhythmogenic right ventricular cardiomyopathy and pulmonary hypertension." European heart journal 34.47 (2013): 3649-3656.
Quattrini, Filippo M., et al. "Benign clinical significance of J-wave pattern (early repolarization) in highly trained athletes." Heart Rhythm 11.11 (2014): 1974-1982.
Sharma, Sanjay, et al. "Electrocardiographic changes in 1000 highly trained junior elite athletes." British Journal of Sports Medicine 33.5 (1999): 319-324.
Drezner, Jonathan A., et al. "Normal electrocardiographic findings: recognising physiological adaptations in athletes." British journal of sports medicine 47.3 (2013): 125-136.
Papadakis, Michael, et al. "Prevalence and significance of T-wave inversions in predominantly Caucasian adolescent athletes." European heart journal 30.14 (2009): 1728-1735.
Migliore, Federico, et al. "Prevalence of cardiomyopathy in Italian asymptomatic children with electrocardiographic T-wave inversion at preparticipation screening." Circulation 125.3 (2012): 529-538.
Meytes, Ilan, et al. "Wenckebach AV block: a frequent feature following heavy physical training." American heart journal 90.4 (1975): 426-430.
Kim, Jonathan H., et al. "Significance of electrocardiographic right bundle branch block in trained athletes." The American journal of cardiology 107.7 (2011): 1083-1089.
Tintinalli JE, et al. Tintinalli’s Emergency Medicine. 8th ed. New York: McGraw-Hill; 2015. 127-9, Voltage Criteria for Left and Right Hypertrophy by Age
MOSS and ADAMS tenth Edition-2022, Table:19.2 Normal ECG standarts for Children by Age, page 1530
Referanslar
Sharma, Sanjay, et al. "International recommendations for electrocardiographic interpretation in athletes." European heart journal 39.16 (2018): 1466-1480.
Fritsch, Peter, et al. "Cardiovascular pre-participation screening in young athletes: recommendations of the Association of European Paediatric Cardiology." Cardiology in the Young 27.9 (2017): 1655-1660.
Prutkin, Jordan M., and Mathew G. Wilson. "Electrocardiography in athletes: normal and abnormal findings." Heart 104.23 (2018): 1902-1909.
McClean, Gavin, et al. "Electrical and structural adaptations of the paediatric athlete’s heart: a systematic review with meta-analysis." British journal of sports medicine 52.4 (2018): 230-230.
Stein, Ricardo, et al. "Intrinsic sinus and atrioventricular node electrophysiologic adaptations in endurance athletes." Journal of the American College of Cardiology 39.6 (2002): 1033-1038.
Meytes, Ilan, et al. "Wenckebach AV block: a frequent feature following heavy physical training." American heart journal 90.4 (1975): 426-430.
D’Souza, Alicia, et al. "Exercise training reduces resting heart rate via downregulation of the funny channel HCN4." Nature communications 5.1 (2014): 3775.
Calore, Chiara, et al. "Prevalence and clinical meaning of isolated increase of QRS voltages in hypertrophic cardiomyopathy versus athlete's heart: relevance to athletic screening." International journal of cardiology 168.4 (2013): 4494-4497.
Sathanandam, Shyam, et al. "ECG screening criteria for LVH does not correlate with diagnosis of hypertrophic cardiomyopathy." (2009): S647-S647.
Zaidi, Abbas, et al. "Clinical significance of electrocardiographic right ventricular hypertrophy in athletes: comparison with arrhythmogenic right ventricular cardiomyopathy and pulmonary hypertension." European heart journal 34.47 (2013): 3649-3656.
Quattrini, Filippo M., et al. "Benign clinical significance of J-wave pattern (early repolarization) in highly trained athletes." Heart Rhythm 11.11 (2014): 1974-1982.
Sharma, Sanjay, et al. "Electrocardiographic changes in 1000 highly trained junior elite athletes." British Journal of Sports Medicine 33.5 (1999): 319-324.
Drezner, Jonathan A., et al. "Normal electrocardiographic findings: recognising physiological adaptations in athletes." British journal of sports medicine 47.3 (2013): 125-136.
Papadakis, Michael, et al. "Prevalence and significance of T-wave inversions in predominantly Caucasian adolescent athletes." European heart journal 30.14 (2009): 1728-1735.
Migliore, Federico, et al. "Prevalence of cardiomyopathy in Italian asymptomatic children with electrocardiographic T-wave inversion at preparticipation screening." Circulation 125.3 (2012): 529-538.
Meytes, Ilan, et al. "Wenckebach AV block: a frequent feature following heavy physical training." American heart journal 90.4 (1975): 426-430.
Kim, Jonathan H., et al. "Significance of electrocardiographic right bundle branch block in trained athletes." The American journal of cardiology 107.7 (2011): 1083-1089.
Tintinalli JE, et al. Tintinalli’s Emergency Medicine. 8th ed. New York: McGraw-Hill; 2015. 127-9, Voltage Criteria for Left and Right Hypertrophy by Age
MOSS and ADAMS tenth Edition-2022, Table:19.2 Normal ECG standarts for Children by Age, page 1530
